Brigadier Surgeon Questions

[Catfish-Cupcake]

Hello Milmed,

Incoming M1 here- currently working on both AF (3-year) and Army (4-year) HPSP scholarships. I have been researching both of these scholarships and the fine print associated with both. I have decided I would be okay with becoming a flight surgeon in the AF, but I can't find very much information about brigadier surgeons in the Army.

As I understand it, a brigadier surgeon slot is a 2-year post residency stint that is 50-50 clerical/clinical work and is generally filled by primary care docs. Assuming I want to go into family med, my questions are:

1. Is this a deploying position or do you get stationed at a US military base? I'm joining because I want to deploy, but two years abroad would be hard time spent away from my family. If I would get stationed in the US than no big deal.

2. Does essentially everyone entering an Army primary care slot get one of these positions? If not, than how frequently are they given out?

3. Does it make a difference if one wants to serve their 4-years and get out or work as an Army physician until retirement?

I guess these are basically all my questions. If anyone wants to chime in why they prefer one branch over another please feel free to give me your options. Thank you.

Edit: Forgot to mention, I am weighing these two options because as of now I can be awarded a 4-year Army scholarship but the AF can only give me a 3-year.

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[HighPriest]

You are misinformed about the position being 50/50 clinical. It is more often entirely non-clinical, which is what frightens most people. If you're a surgeon, it's essentially 100% non-clinical, and you come out of it undoubtedly in a very bad way (unless you're interested in a military career and not in continuing the practice of medicine.)

1-yes. You would be stationed at a military post, most of which are CONUS, but you would deploy if necessary. But it isn't a guaranteed deployment. If you want a guaranteed deployment, be a general surgeon. You'll deploy so often, you'll have to write down your home address to remember how to get back.

2 - not everyone gets it. It's very rare, but arguably more damaging, for specialists and more common for primary care. But I assure you that if you volunteer, you'll get to be one.

3- only in the sense that if you want to get out of the Army and have a meaningful clinical career, you probably want to avoid the chamber with the bullet, which is the brigade surgeon spot. If you want to stay in for 20, and your clinical prowess is less important to you than your expertise on form-filling, OER-buffing, and chain-of-command, then a BS spot is perfect for you. And so is the Army. You're exactly what they want.

 

[Catfish-Cupcake]

You are misinformed about the position being 50/50 clinical. It is more often entirely non-clinical, which is what frightens most people. If you're a surgeon, it's essentially 100% non-clinical, and you come out of it undoubtedly in a very bad way (unless you're interested in a military career and not in continuing the practice of medicine.)

1-yes. You would be stationed at a military post, most of which are CONUS, but you would deploy if necessary. But it isn't a guaranteed deployment. If you want a guaranteed deployment, be a general surgeon. You'll deploy so often, you'll have to write down your home address to remember how to get back.

2 - not everyone gets it. It's very rare, but arguably more damaging, for specialists and more common for primary care. But I assure you that if you volunteer, you'll get to be one.

3- only in the sense that if you want to get out of the Army and have a meaningful clinical career, you probably want to avoid the chamber with the bullet, which is the brigade surgeon spot. If you want to stay in for 20, and your clinical prowess is less important to you than your expertise on form-filling, OER-buffing, and chain-of-command, then a BS spot is perfect for you. And so is the Army. You're exactly what they want.

Thank you for writing me such a detailed and informative response. Its hard to being 100% certain when I'm considering signing onto so many years of service, but I feel better about it now. Some previous posters made it seem like a BS slot is 100% if you're primary care.

 

[jabreal00]

Hello Milmed,

Incoming M1 here- currently working on both AF (3-year) and Army (4-year) HPSP scholarships. I have been researching both of these scholarships and the fine print associated with both. I have decided I would be okay with becoming a flight surgeon in the AF, but I can't find very much information about brigadier surgeons in the Army.

As I understand it, a brigadier surgeon slot is a 2-year post residency stint that is 50-50 clerical/clinical work and is generally filled by primary care docs. Assuming I want to go into family med, my questions are:

1. Is this a deploying position or do you get stationed at a US military base? I'm joining because I want to deploy, but two years abroad would be hard time spent away from my family. If I would get stationed in the US than no big deal.

2. Does essentially everyone entering an Army primary care slot get one of these positions? If not, than how frequently are they given out?

3. Does it make a difference if one wants to serve their 4-years and get out or work as an Army physician until retirement?

I guess these are basically all my questions. If anyone wants to chime in why they prefer one branch over another please feel free to give me your options. Thank you.

Edit: Forgot to mention, I am weighing these two options because as of now I can be awarded a 4-year Army scholarship but the AF can only give me a 3-year.

The Brigade Surgeon slot is generally an administrative position, 90% administrative 10% clinical. If one is primary care then they can see more clinic (usually troops within the Brigade). Keep in mind clinic is for the young troops in the Brigade so clinic consists of lumps, bumps, STDs and malingerers. However, sub-specialist or other specialists outside of primary would need to arrange some sort of way to get 1/2 a day a week at a local military treatment facility on their own. This time away is not guaranteed and is pending final approval of the Brigade commander. The Brigade Surgeon is the medical liaison to the Brigade Commander which is generally a Colonel. The Brigade Surgeon will manage several physician assistants as well as one or two general medical officers (battalion surgeons). Big emphasis is on unit medical readiness; ensuring troops have all their vaccines, troops triage to rehab who are injured or troops getting discharged if their injury or illness precludes military service. Most of these assignments are within the continental United States (to include Hawaii). You deploy with the Brigade. So when ever the Brigade gets deployment orders you deploy with them for the entire time (9-12 months). In this job the minutia of being a military officer is what will be learned. There is no growth as a clinician during this time.

Traditionally, primary care providers filled this roll, however within the last 3-5 years it's been filled by other specialties to include ENT, Radiology, Dermatology, Anesthesiology etc. General surgeons or orthopedics have a similar assignment as a FST commander.

If one is paying back just 3 or 4 years in the military after their residency, there's a good chance that they will not get this assignment. However, if one plans on staying longer the 4 years, the odds of involuntarily getting this assignment increases. Some may choose it because it helps for their evaluation in order to progress in rank or get other "plum" assignments.

Air Force is smaller than the Army. So locations for training spots are limited. I think, based on my perception, the Air Force treats their military physician better (caveat my wife was previous air force HPSP and I was Army). There are more crappy locations in the Army by the fact of having more medical treatment facilities. There are more operational (ie non clinical) assignments in the Army.

 

[notdeadyet]

I think, based on my perception, the Air Force treats their military physician better (caveat my wife was previous air force HPSP and I was Army).

I've heard this before many times on this forum.

I'm curious: does the Air Force really treat their physician's (specifically) better than the Army? Or does the Air Force just treat their people (generally) better than the Army?

Wondering if this is a we-love-our-docs thing or just the fact that they globally treat their people (or at least officers) better than the Army does.

 

[jabreal00]

I've heard this before many times on this forum.

I'm curious: does the Air Force really treat their physician's (specifically) better than the Army? Or does the Air Force just treat their people (generally) better than the Army?

Wondering if this is a we-love-our-docs thing or just the fact that they globally treat their people (or at least officers) better than the Army does.

Hard to tell. I know that when my wife and I came on separation orders, her specialty consultant bent over backwards to try to keep us together, basically making up a spot for her while mine was like, "then needs of the Army" comes first. I think their officers and more specifically those in the medical corp are treated more professionally. Army has much more of a "hazing" culture; 15 month deployments during height of OIF & OEF, involuntary Brigade Surgeon assignments etc. Just my opinion.

 

[68PGunner]

Hello Milmed,

Incoming M1 here- currently working on both AF (3-year) and Army (4-year) HPSP scholarships. I have been researching both of these scholarships and the fine print associated with both. I have decided I would be okay with becoming a flight surgeon in the AF, but I can't find very much information about brigadier surgeons in the Army.

As I understand it, a brigadier surgeon slot is a 2-year post residency stint that is 50-50 clerical/clinical work and is generally filled by primary care docs. Assuming I want to go into family med, my questions are:

1. Is this a deploying position or do you get stationed at a US military base? I'm joining because I want to deploy, but two years abroad would be hard time spent away from my family. If I would get stationed in the US than no big deal.

2. Does essentially everyone entering an Army primary care slot get one of these positions? If not, than how frequently are they given out?

3. Does it make a difference if one wants to serve their 4-years and get out or work as an Army physician until retirement?

I guess these are basically all my questions. If anyone wants to chime in why they prefer one branch over another please feel free to give me your options. Thank you.

Edit: Forgot to mention, I am weighing these two options because as of now I can be awarded a 4-year Army scholarship but the AF can only give me a 3-year.

If you are determined to take the HPSP, I would take the 3 YR AF HPSP over the 4 YR Army HPSP over in any day of the week. The professional culture in the AF caters more toward a physician's needs and lifestyle.

 

[Catfish-Cupcake]

If you are determined to take the HPSP, I would take the 3 YR AF HPSP over the 4 YR Army HPSP over in any day of the week. The professional culture in the AF caters more toward a physician's needs and lifestyle.

Might end up that way. I haven't heard back from my Army recruiter in a while, which brings up another question:

Do you or anyone else know if there are 4 year Army scholarships going unfilled? I didn't even contact the recruiter with the intention of applying for anything but a 3 year. The army recruiter seems certain I'll still get a 4 year contract though- which seems wrong to me just because of how late it is. (I start school in just over a month for M1)

 

[68PGunner]

Might end up that way. I haven't heard back from my Army recruiter in a while, which brings up another question:

Do you or anyone else know if there are 4 year Army scholarships going unfilled? I didn't even contact the recruiter with the intention of applying for anything but a 3 year. The army recruiter seems certain I'll still get a 4 year contract though- which seems wrong to me just because of how late it is. (I start school in just over a month for M1)

4 YR Army HPSP slots for medical students go unfilled every year. There's a reason to it. I would take the AF one because the Army won't lock you in that Brigade Surgeon slot after residency and in essence force you to stay with the Army for another 4 years in order to regain your clinical skills.

You and I have been both on the enlisted side. Putting talented people in skills degrading positions is the Army way of business in order to keep them in the grinder.

 

[psychbender]

Because of some stupid **** with my recruiters, I didn't officially have my four year HPSP scholarship until a few weeks into my first year of med school. I kept telling my school that the Army is good for it, just wait another week. It helped that we had over twenty HPSP students in each class, so they understood some military BS.

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[Catfish-Cupcake]

Thanks for your opinions everyone. I'm starting to lean Army just because of more GME. Hopefully everything works out!

 

[Kilgoretrout 65]

Thanks for your opinions everyone. I'm starting to lean Army just because of more GME. Hopefully everything works out!

Good luck. I am an Air Force doc in an Army hospital. It is easier to get promoted in the Air Force (haven't looked at the numbers lately) and our leave policy makes taking leave pretty simple. After that, it is hard for me to say. The Army at least has MEDCOM so your bosses are docs (most of the time exception being those dentist commanders and nurse surgeon generals). Air Force leadership structure has had me work for physical therapists, nurses, social workers, BSCs MSCs you name it. Not sure that matters as it is more about who the boss is and not where they came from. Probably easier to stay a clinical 06 in the Army. The Air Force doesn't have the brigade surgeon thing. It is probably easier to train civilian in residency or get a civilian sponsored fellowship in the Air Force.

 

[HighPriest]

Good luck. I am an Air Force doc in an Army hospital. It is easier to get promoted in the Air Force (haven't looked at the numbers lately) and our leave policy makes taking leave pretty simple. After that, it is hard for me to say. The Army at least has MEDCOM so your bosses are docs (most of the time exception being those dentist commanders and nurse surgeon generals). Air Force leadership structure has had me work for physical therapists, nurses, social workers, BSCs MSCs you name it. Not sure that matters as it is more about who the boss is and not where they came from. Probably easier to stay a clinical 06 in the Army. The Air Force doesn't have the brigade surgeon thing. It is probably easier to train civilian in residency or get a civilian sponsored fellowship in the Air Force.

There is absolutely no guarantee that your boss will be a doc in the Army. My last three were a physical therapist and two nurses, and all under a nurse hospital commander. Only at my most recent duty station has anyone in the DOS command chain actually been a surgeon. Maybe it's worse in the AF, but it ain't good in the Army.
And there is essentially a 0% chance of making O-6 doing only clinical medicine in the Army today. I'd wager anyone you know in that situation is from another era, but even if they aren't, the word from OTSG is that those days are over. You will take operational jobs to make it to O-6, and most people need them to get O-5, unless you're at one of the big four MEDCENs.

 

[Catfish-Cupcake]

The AF recruiter I have spoken with told me that you will not become a flight surgeon unless you want to. I'm not sure whether to believe her- I was under the impression that to obtain a competitive specialty you generally need a FS tour under you're belt. What have you seen in your experience?

Also, do students normally prefer civ deferral or AF GME position?

Good luck. I am an Air Force doc in an Army hospital. It is easier to get promoted in the Air Force (haven't looked at the numbers lately) and our leave policy makes taking leave pretty simple. After that, it is hard for me to say. The Army at least has MEDCOM so your bosses are docs (most of the time exception being those dentist commanders and nurse surgeon generals). Air Force leadership structure has had me work for physical therapists, nurses, social workers, BSCs MSCs you name it. Not sure that matters as it is more about who the boss is and not where they came from. Probably easier to stay a clinical 06 in the Army. The Air Force doesn't have the brigade surgeon thing. It is probably easier to train civilian in residency or get a civilian sponsored fellowship in the Air Force.

 

[Catfish-Cupcake]

There is absolutely no guarantee that your boss will be a doc in the Army. My last three were a physical therapist and two nurses, and all under a nurse hospital commander. Only at my most recent duty station has anyone in the DOS command chain actually been a surgeon. Maybe it's worse in the AF, but it ain't good in the Army.
And there is essentially a 0% chance of making O-6 doing only clinical medicine in the Army today. I'd wager anyone you know in that situation is from another era, but even if they aren't, the word from OTSG is that those days are over. You will take operational jobs to make it to O-6, and most people need them to get O-5, unless you're at one of the big four MEDCENs.

So what has your experience been like with having non-physicians as your superiors?

 

[Red Lobster Actual]

The AF recruiter I have spoken with told me that you will not become a flight surgeon unless you want to. I'm not sure whether to believe her- I was under the impression that to obtain a competitive specialty you generally need a FS tour under you're belt. What have you seen in your experience?

This is definitely more of a Navy thing. Flight surgery tours in the AF are for those that want a star and the royal screw ups.

 

[HighPriest]

So what has your experience been like with having non-physicians as your superiors?

Not good. They only come in two forms: the kind that realize that they don't know what you do for a living, and the kind that don't. The second type is by far more common.

 

[Kilgoretrout 65]

The AF recruiter I have spoken with told me that you will not become a flight surgeon unless you want to.

You may or may not get that competitive residency. It is true that you have to want to be a flight surgeon but the alternative is being a GMO seeing more clinic patients and without the fancy flight suit so technically the recruiter is right.

 

[HighPriest]

You may or may not get that competitive residency. It is true that you have to want to be a flight surgeon but the alternative is being a GMO seeing more clinic patients and without the fancy flight suit so technically the recruiter is right.

Technically right - the only federally approved kind of right.